Immunization safety net needs reinforcement

April 20, 2001

Health department clinics play a large role in caring for vulnerable children, but could stand to improve certain aspects of their service, suggest the results of a new survey.

These clinics help ensure the immunization of vulnerable children, which "is essential to their health and the health of our nation as a whole--this immunization safety net must be preserved," says the study's lead author Jeanne M. Santoli, M.D., M.P.H., of the National Immunization Program at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

Santoli and colleagues surveyed 166 local health department clinics located in large urban communities, smaller communities or rural communities. Approximately 20% of these clinics provided comprehensive care, which means that most patients immunized in these clinics, the majority of whom were uninsured or on Medicaid, had to visit additional primary care sources for other preventive health services, the researchers found.

"This need for extra visits creates missed opportunities and is problematic for vulnerable children," notes Santoli.

The study results are published in the May issue of the American Journal of Preventive Medicine.

The researchers also found that some clinics weren't implementing certain recommended practices, including the use of patient reminders, semiannual assessments of immunization coverage and extended clinic hours. This finding may reflect a 50% decrease in federal funding for immunization delivery infrastructure since 1996, according to the study.

The clinics did commonly implement less costly recommended standards, however, including giving up to four vaccinations per patient visit and routinely checking immunization status, the researchers note.

Clinics tend to lack effective methods of informing primary care providers about health department immunizations, found the researchers, who recommend the increased use of immunization registries as one possible strategy.

"Relying on parents to transmit immunization information between providers may exacerbate barriers to immunization," notes Santoli.

Santoli and colleagues were surprised to find most clinics don't participate in managed care, even though many of the children they immunize probably have some sort of public insurance coverage. "Clinics could try to improve their financial standing by billing third-party payers for services rendered and by participating as providers in managed care," says Santoli.

The researchers note health department clinics appear to be providing more immunization services to adolescents than in the past, perhaps reflecting new recommendations and school requirements.

"These findings suggest many adolescents do not have a strong link with a medical home, and that, when immunizations are required for school enrollment, adolescents depend on local health departments," she says.

"Although the majority of these clinics do not provide comprehensive care, they continue to serve vulnerable children, including adolescents, Medicaid enrollees, and the uninsured, and may represent the main contact with the healthcare system for such patients," concludes Santoli.
The American Journal of Preventive Medicine, sponsored by the Association of Teachers of Preventive Medicine and the American College of Preventive Medicine, is published eight times a year by Elsevier Science. The Journal is a forum for the communication of information, knowledge and wisdom in prevention science, education, practice and policy. For more information about the Journal, contact the editorial office at 619-594-7344.

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